J Trauma
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The Injury Severity Score (ISS) is widely used for anatomic severity assessments. The ISS is the sum of the squares of a patient's three worst Abbreviated Injury Scale (AIS) severities (1-6) from three specified body regions. The set of three AIS severities (including 0s) is called a "triplet." ISS values of 9, 17, 18, 25, 26, 27, 29, 33, 34, 41, and 50 can originate from two unique triplets, but it is not clear whether the mortalities of the triplets are equal. A related question regards the monotonicity of the ISS, that is, whether mortality increases with successive values of ISS. This study sought to compare the mortality of equivalent ISS values from different triplets and to evaluate whether ISS is a monotonic function of mortality. ⋯ The ISS is a nonmonotonic, triplet-dependent function of mortality. Those who persist in using the ISS to describe populations or make risk adjustments should do so cautiously, being sure to account for triplet type. These suspect ISS values appear in approximately 25% of cases.
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Uncontrolled hemorrhage is a leading cause of death in cases of trauma. Many products currently are under development to control traumatic bleeding. One such Food and Drug Administration (FDA)-approved product is QuikClot. This study determined the efficacy of QuikClot, a hemostatic agent, in reducing blood loss and mortality in a standardized model of severe liver injury as well as the consequences of its use. ⋯ QuikClot provides hemostasis and decreased mortality in this model of severe liver injury. The beneficial aspects of QuikClot treatment must, however, be balanced against the tissue-damaging effects of the exothermic reaction.
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A central question in suicide research is whether firearm availability increases the overall number of suicides rather than the proportion of suicides from guns. ⋯ When it comes to suicide, the availability of household firearms matters-a lot.
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Methylene blue has been used to treat hypovolemic states. This study evaluated prehospital resuscitation after refractory hemorrhagic shock with a combination of methylene blue and limited-volume lactated Ringer's solution. ⋯ Resuscitation after refractory hemorrhagic shock using a combination of methylene blue and limited-volume lactated Ringer's solution improves prehospital survival and hemodynamic stability and reduces ischemic damage in an acute setting. This form of therapy has been proved useful as a temporizing measure for resuscitation after refractory hemorrhagic shock in a canine model and warrants further study for its application to the hemorrhagic trauma patient.